ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Energy levels affect the treatment efficacy and efficiency of electroconvulsive therapy (ECT). United States devices require preselection of energy dosage before stimulating patients, and two strategies have been proposed to determine an effective dosage, i.e., based on the patient's age and measured estimates of seizure threshold. The age method is criticized for overstimulation and an assumed association with increased cognitive effects. Threshold determination strategy is cumbersome and requires multiple stimulations, possibly placing patients at increased cardiovascular risk. In 35 patients, we examined an energy estimate for bilateral electrode placement at half the patient's age in “percent of energy” or joules delivered by the Thymatron and MECTA devices. Each patient required one stimulation in the first treatment to elicit motor seizures averaging 51.7 s. Subsequently, 20 patients were randomly assigned to either threshold titration followed by half-age for the first two treatments or the opposite (AB-BA design). Half-age energy was 7 J (30%) higher than titration estimates, corresponding to 55% energy of the age method. The relation of half-age and titration estimates were confirmed in energy dosing records from two independent centers. Energy dosing by half-age calculation in bilateral ECT is simple, practical, avoids overdosing and repeat stimulation, and is a useful substitute for the more complex strategy based on threshold estimation.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Twenty-two patients with major depression received a course of right unilateral ECT. The convulsive threshold (CT) was determined on the first treatment. Subsequent treatments were −2.25 times CT. Seizure morphology for treatments 2–6 were rated for regularity (0–6 scale; low-high) and postictal suppression (0–3; low-high). Ratings of postictal suppression were log transformed to improve the approximation to a normal distribution. A preliminary analysis of variance with CT as the independent variable compared the seizure ratings at low, mid, and high CT. Second, linear regression models for the mean values of seizure regularity and postictal suppression were determined using age, gender, and the CT as predictor variables. The degree of postictal suppression varied inversely with age, male gender, and CT in this study. Our results suggested that CT made the greatest contribution to the model. Future studies examining the predictive value of seizure morphology parameters to clinical outcome should include measurement of CT.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In the research phase of the National Suicide Prevention Project in Finland, all completed suicides in Finland (N= 1,397) within a 12-month period were comprehensively examined by using the psychological autopsy method. In this study, we examined the number of cases having received electroconvulsive therapy (ECT) during the 3 final months before suicide. Only two such cases (0.14% of all suicides) were found, a figure remarkably low considering the high prevalence of severe depression in the suicide population. In both of the two cases, the quality of treatment was questionable, and suicide occurred during a depressive relapse. The findings indirectly support earlier reports suggesting ECT to have a preventive effect concerning suicide. However, alternative explanations, such as low base rate of use of ECT in Finland during the study period, or withholding ECT from some patients because of comorbidity, as well as a combined effect of all the three factors, need also to be considered. Among all suicides, those within 3 months after ECT are rare, and the possible efficacy of ECT in preventing suicide warrants further study.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Three patients had exceptionally high seizure threshold, as determined by an empirical titration procedure. Initial seizure threshold was 896 mC in two of the patients. The third patient had an initial threshold of 336 mC that increased to 840 mC at the end of the course of electroconvulsive therapy (ECT), and remained elevated during a second course of ECT. All three patients were elderly men with complicated medical histories and ongoing low-dose benzodiazepine use. Each patient had an excellent response to ECT delivered with a custom modified device, capable of delivering more than twice the charge of ECT devices presently commercially available in the United States. Implications for the administration of ECT in patients with exceptionally high seizure threshold and the limitations of current device output are discussed.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Cerebral aneurysms or recent surgical repair of aneurysms are relative contraindications for electroconvulsive therapy (ECT), yet the literature contains at least three cases in which ECT resulted in no known CNS complications. The following case describes a course of ECT in a patient 4 months after he had undergone surgical repair of a posterior cerebral artery aneurysm. Blood pressure control in patients with CNS aneurysms and repaired aneurysms can be achieved through choice of anesthetic agent, and intravenous antihypertensives, thus reducing the risk of cerebrovascular complications.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID